Last week at the annual meeting of the American Medical Association in Chicago, the organization's delegates voted for the first time to designate obesity
a disease. How should the rest of us respond? When we meet obese people, should we cast them a knowing glance of concern and ask how they are doing? Should
we send flowers and "get well soon" cards to obese family members and friends?

If obesity truly is a disease, then over 78 million adults and 12 million children in America just got classified as sick. Their ranks have included a number of
prominent people, such as actors John Goodman and Kathy Bates, musicians BB King and Aretha Franklin, politicians Al Gore and Newt Gingrich, professional
athletes John Kruk and Charles Barkley, media personalities Oprah Winfrey and Michael Moore, and Microsoft CEO Steve Ballmer. Everyone has friends and
acquaintances who now qualify as diseased.

It would be as false to say that everyone who is obese is sick as to say that every normal-weight person is well.

Yet many sensible people, from physicians to philosophers, know that declaring obesity a disease is a mistake. Simply put, obesity is not a disease. To be
sure, it is a risk factor for some diseases. But it would be as false to say that everyone who is obese is sick as to say that every normal-weight person
is well. Hence the AMA's vote raises some key questions. Why did it take this action? What is problematic about treating obesity as a disease? And how
should sensible people think about obesity?

One reason for naming obesity a disease is the fact that being markedly overweight is positively correlated with a variety of health problems. Some of
these problems are risk factors for diseases, such as hypertension, abnormal blood lipid levels, and sleep apnea. Others are diseases in their own right,
such as heart attack, stroke, gallbladder disease, and osteoarthritis. Obesity is also a risk factor for some cancers, including those of the
endometrium, breast, and colon.

Another reason for declaring obesity a disease is financial. It will nudge health care payers, including private insurers and the federal government, to
pay for anti-obesity services, including weight loss counseling and programs. Why, proponents ask, should we pay physicians and hospitals tens of thousands
of dollars to open blocked arteries yet refuse to spend a fraction of this amount on diet and fitness programs that might prevent the problem in the first
place?

Yet everyone who is obese does not get sick, and many normal-weight people do not stay healthy. I have known slim and trim people who took scrupulous care
of themselves throughout their lives yet fell ill and died young. Others who exhibited no particular interest in their health and did not watch their
weight lived to a ripe old age. In most cases, we simply cannot tell from a person's weight what lies ahead for them in life.

Consider Winston Churchill. Though average in height, Churchill weighed upwards of 250 pounds. He smoked cigars. He drank relatively heavily. He did not
jog or work out. Yet he became perhaps the most important statesmen of the 20th century and one of the greatest political orators in history. He served
twice as Britain's prime minister, guiding his nation through a particularly perilous chapter in its history, and won the Nobel Prize for literature. He
lived to age 90.

Thinner isn't always better. A number of epidemiological studies have concluded that normal-weight people are in fact at higher risk of some diseases,
including cardiovascular disease, compared to those whose who are overweight. And there are health conditions for which being overweight is actually
protective. For example, heavier women are less likely to develop osteoporosis than thin women. Likewise, among the elderly, being somewhat overweight is
often an indicator of good health.

Of even greater concern is the fact that obesity turns out to be very difficult to delineate. It is often defined in terms of body mass index, or BMI. BMI
equals body mass divided by the square of height. An adult with a BMI of 18 to 25 is often considered to be normal weight. Between 25 and 30 is overweight.
And over 30 is considered obese. Obesity, in turn, can be divided into moderately obese (30 to 35), severely obese (35 to 40), and very severely obese
(over 40).

A hearty appetite generally indicates health and may even suggest that a person knows how to enjoy life.

While such numerical standards seem straightforward, they are not. Obesity is
probably less a matter of weight than body fat
. Some people with a high BMI are in fact extremely fit, while others with a low BMI may be in poor shape. For example, many collegiate and professional
football players qualify as obese, though their percentage body fat is low. By BMI, Dwayne "The Rock" Johnson is obese. Conversely, someone with a small
frame may have high body fat but a normal BMI.

Today we have a tendency to stigmatize obesity. The overweight are sometimes pictured in the media with their faces covered. Stereotypes associated with
obesity include laziness, lack of will power, and lower prospects for success. Teachers, employers, and health professionals have been shown to harbor
biases against the obese. Even
very young children tend to look down on the overweight, and teasing about body build has long been a problem in schools.

Negative attitudes toward obesity, grounded in health concerns, have stimulated a number of anti-obesity policies. My own hospital system has banned sugary
drinks from its facilities, making it impossible to purchase a non-diet soft drink there. Many employers have instituted weight loss and fitness
initiatives. Michelle Obama has launched a high-visibility campaign against childhood obesity, even telling Dr. Oz that it represents our greatest national
security threat.

The track record of governmental anti-obesity initiatives is mixed at best. One of the most widely reported was Denmark's so-called "fat tax," which
consisted of a surcharge on all foods with a saturated fat content greater than 2.3 percent. The result? Danes switched to lower-cost versions of the same
foods and began doing more of their shopping internationally, making their purchases in fat-tax-free countries. The fat tax lasted about a year before it
was repealed.

In many cultures throughout history and even today, plump has been preferred to thin. Consider, for example, Shakespeare's Falstaff or the paintings of
Peter Paul Rubens. In a community full of people who struggle to get enough to eat, being well-fed and having a well-fed family is often a sign of success.
A hearty appetite generally indicates health and may even suggest that a person knows how to enjoy life.

Related Story

This reminds me of a story about Herman Wells, the long-time president and chancellor of Indiana University. Wells was obese from childhood throughout his
adult life. In preparation for minor surgery, his physician once advised him to lose 20 pounds. "That's easy," Wells replied. "I have done that dozens of
times." Wells accepted his weight. He did not torture himself about it. In fact, he could even laugh about it, and he did so throughout all 97 years of his
full life.

Is obesity bad for people? For some, especially patients who are extremely overweight, the answer is almost certainly yes. Would many overweight people
benefit from exercising more and eating less? Again, the answer is likely yes. But this does not make obesity a disease. Many people are not harmed by
carrying extra pounds, some may actually benefit from it, and we have yet to define it authoritatively. For these reasons, we should think twice before
labeling obese people diseased.

About the Author

Richard Gunderman, MD, PhD, is a contributing writer for The Atlantic. He is a professor of radiology, pediatrics, medical education, philosophy, liberal arts, and philanthropy, and vice-chair of the Radiology Department, at Indiana University. Gunderman's most recent book is X-Ray Vision.

Most Popular

Writing used to be a solitary profession. How did it become so interminably social?

Whether we’re behind the podium or awaiting our turn, numbing our bottoms on the chill of metal foldout chairs or trying to work some life into our terror-stricken tongues, we introverts feel the pain of the public performance. This is because there are requirements to being a writer. Other than being a writer, I mean. Firstly, there’s the need to become part of the writing “community”, which compels every writer who craves self respect and success to attend community events, help to organize them, buzz over them, and—despite blitzed nerves and staggering bowels—present and perform at them. We get through it. We bully ourselves into it. We dose ourselves with beta blockers. We drink. We become our own worst enemies for a night of validation and participation.

Even when a dentist kills an adored lion, and everyone is furious, there’s loftier righteousness to be had.

Now is the point in the story of Cecil the lion—amid non-stop news coverage and passionate social-media advocacy—when people get tired of hearing about Cecil the lion. Even if they hesitate to say it.

But Cecil fatigue is only going to get worse. On Friday morning, Zimbabwe’s environment minister, Oppah Muchinguri, called for the extradition of the man who killed him, the Minnesota dentist Walter Palmer. Muchinguri would like Palmer to be “held accountable for his illegal action”—paying a reported $50,000 to kill Cecil with an arrow after luring him away from protected land. And she’s far from alone in demanding accountability. This week, the Internet has served as a bastion of judgment and vigilante justice—just like usual, except that this was a perfect storm directed at a single person. It might be called an outrage singularity.

Forget credit hours—in a quest to cut costs, universities are simply asking students to prove their mastery of a subject.

MANCHESTER, Mich.—Had Daniella Kippnick followed in the footsteps of the hundreds of millions of students who have earned university degrees in the past millennium, she might be slumping in a lecture hall somewhere while a professor droned. But Kippnick has no course lectures. She has no courses to attend at all. No classroom, no college quad, no grades. Her university has no deadlines or tenure-track professors.

Instead, Kippnick makes her way through different subject matters on the way to a bachelor’s in accounting. When she feels she’s mastered a certain subject, she takes a test at home, where a proctor watches her from afar by monitoring her computer and watching her over a video feed. If she proves she’s competent—by getting the equivalent of a B—she passes and moves on to the next subject.

The Wall Street Journal’s eyebrow-raising story of how the presidential candidate and her husband accepted cash from UBS without any regard for the appearance of impropriety that it created.

The Swiss bank UBS is one of the biggest, most powerful financial institutions in the world. As secretary of state, Hillary Clinton intervened to help it out with the IRS. And after that, the Swiss bank paid Bill Clinton $1.5 million for speaking gigs. TheWall Street Journal reported all that and more Thursday in an article that highlights huge conflicts of interest that the Clintons have created in the recent past.

The piece begins by detailing how Clinton helped the global bank.

“A few weeks after Hillary Clinton was sworn in as secretary of state in early 2009, she was summoned to Geneva by her Swiss counterpart to discuss an urgent matter. The Internal Revenue Service was suing UBS AG to get the identities of Americans with secret accounts,” the newspaper reports. “If the case proceeded, Switzerland’s largest bank would face an impossible choice: Violate Swiss secrecy laws by handing over the names, or refuse and face criminal charges in U.S. federal court. Within months, Mrs. Clinton announced a tentative legal settlement—an unusual intervention by the top U.S. diplomat. UBS ultimately turned over information on 4,450 accounts, a fraction of the 52,000 sought by the IRS.”

There’s no way this man could be president, right? Just look at him: rumpled and scowling, bald pate topped by an entropic nimbus of white hair. Just listen to him: ranting, in his gravelly Brooklyn accent, about socialism. Socialism!

And yet here we are: In the biggest surprise of the race for the Democratic presidential nomination, this thoroughly implausible man, Bernie Sanders, is a sensation.

He is drawing enormous crowds—11,000 in Phoenix, 8,000 in Dallas, 2,500 in Council Bluffs, Iowa—the largest turnout of any candidate from any party in the first-to-vote primary state. He has raised $15 million in mostly small donations, to Hillary Clinton’s $45 million—and unlike her, he did it without holding a single fundraiser. Shocking the political establishment, it is Sanders—not Martin O’Malley, the fresh-faced former two-term governor of Maryland; not Joe Biden, the sitting vice president—to whom discontented Democratic voters looking for an alternative to Clinton have turned.

During the multi-country press tour for Mission Impossible: Rogue Nation, not even Jon Stewart has dared ask Tom Cruise about Scientology.

During the media blitz for Mission Impossible: Rogue Nation over the past two weeks, Tom Cruise has seemingly been everywhere. In London, he participated in a live interview at the British Film Institute with the presenter Alex Zane, the movie’s director, Christopher McQuarrie, and a handful of his fellow cast members. In New York, he faced off with Jimmy Fallon in a lip-sync battle on The Tonight Show and attended the Monday night premiere in Times Square. And, on Tuesday afternoon, the actor recorded an appearance on The Daily Show With Jon Stewart, where he discussed his exercise regimen, the importance of a healthy diet, and how he still has all his own hair at 53.

Stewart, who during his career has won two Peabody Awards for public service and the Orwell Award for “distinguished contribution to honesty and clarity in public language,” represented the most challenging interviewer Cruise has faced on the tour, during a challenging year for the actor. In April, HBO broadcast Alex Gibney’s documentary Going Clear, a film based on the book of the same title by Lawrence Wright exploring the Church of Scientology, of which Cruise is a high-profile member. The movie alleges, among other things, that the actor personally profited from slave labor (church members who were paid 40 cents an hour to outfit the star’s airplane hangar and motorcycle), and that his former girlfriend, the actress Nazanin Boniadi, was punished by the Church by being forced to do menial work after telling a friend about her relationship troubles with Cruise. For Cruise “not to address the allegations of abuse,” Gibney said in January, “seems to me palpably irresponsible.” But in The Daily Show interview, as with all of Cruise’s other appearances, Scientology wasn’t mentioned.

An attack on an American-funded military group epitomizes the Obama Administration’s logistical and strategic failures in the war-torn country.

Last week, the U.S. finally received some good news in Syria:.After months of prevarication, Turkey announced that the American military could launch airstrikes against Islamic State positions in Syria from its base in Incirlik. The development signaled that Turkey, a regional power, had at last agreed to join the fight against ISIS.

The announcement provided a dose of optimism in a conflict that has, in the last four years, killed over 200,000 and displaced millions more. Days later, however, the positive momentum screeched to a halt. Earlier this week, fighters from the al-Nusra Front, an Islamist group aligned with al-Qaeda, reportedly captured the commander of Division 30, a Syrian militia that receives U.S. funding and logistical support, in the countryside north of Aleppo. On Friday, the offensive escalated: Al-Nusra fighters attacked Division 30 headquarters, killing five and capturing others. According to Agence France Presse, the purpose of the attack was to obtain sophisticated weapons provided by the Americans.

The Islamic State is no mere collection of psychopaths. It is a religious group with carefully considered beliefs, among them that it is a key agent of the coming apocalypse. Here’s what that means for its strategy—and for how to stop it.

What is the Islamic State?

Where did it come from, and what are its intentions? The simplicity of these questions can be deceiving, and few Western leaders seem to know the answers. In December, The New York Times published confidential comments by Major General Michael K. Nagata, the Special Operations commander for the United States in the Middle East, admitting that he had hardly begun figuring out the Islamic State’s appeal. “We have not defeated the idea,” he said. “We do not even understand the idea.” In the past year, President Obama has referred to the Islamic State, variously, as “not Islamic” and as al-Qaeda’s “jayvee team,” statements that reflected confusion about the group, and may have contributed to significant strategic errors.

Some say the so-called sharing economy has gotten away from its central premise—sharing.

This past March, in an up-and-coming neighborhood of Portland, Maine, a group of residents rented a warehouse and opened a tool-lending library. The idea was to give locals access to everyday but expensive garage, kitchen, and landscaping tools—such as chainsaws, lawnmowers, wheelbarrows, a giant cider press, and soap molds—to save unnecessary expense as well as clutter in closets and tool sheds.

The residents had been inspired by similar tool-lending libraries across the country—in Columbus, Ohio; in Seattle, Washington; in Portland, Oregon. The ethos made sense to the Mainers. “We all have day jobs working to make a more sustainable world,” says Hazel Onsrud, one of the Maine Tool Library’s founders, who works in renewable energy. “I do not want to buy all of that stuff.”

A controversial treatment shows promise, especially for victims of trauma.

It’s straight out of a cartoon about hypnosis: A black-cloaked charlatan swings a pendulum in front of a patient, who dutifully watches and ping-pongs his eyes in turn. (This might be chased with the intonation, “You are getting sleeeeeepy...”)

Unlike most stereotypical images of mind alteration—“Psychiatric help, 5 cents” anyone?—this one is real. An obscure type of therapy known as EMDR, or Eye Movement Desensitization and Reprocessing, is gaining ground as a potential treatment for people who have experienced severe forms of trauma.

Here’s the idea: The person is told to focus on the troubling image or negative thought while simultaneously moving his or her eyes back and forth. To prompt this, the therapist might move his fingers from side to side, or he might use a tapping or waving of a wand. The patient is told to let her mind go blank and notice whatever sensations might come to mind. These steps are repeated throughout the session.